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Paramedic

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By Joel D'Eath Canadian Advance Care Paramedic. Interests include advanced airway, sim training, and pre-hospital emergency care.
https://www.readbyqxmd.com/read/26958801/the-profile-of-wounding-in-civilian-public-mass-shooting-fatalities
#1
Edward Reed Smith, Geoff Shapiro, Babak Sarani
BACKGROUND: The incidence and severity of civilian public mass shootings (CPMS) continue to rise. Initiatives predicated on lessons learned from military woundings have placed strong emphasis on hemorrhage control, especially via use of tourniquets, as means to improve survival. We hypothesize that both the overall wounding pattern and the specific fatal wounds in CPMS events are different from those in military combat fatalities and thus may require a new management strategy. METHODS: A retrospective study of autopsy reports for all victims involved in 12 CPMS events was performed...
July 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27506448/sexual-assault-what-every-emergency-provider-needs-to-know
#2
Rebecca Barron, Elena Kapilevich, Susan Duffy, Alyson J McGregor
No abstract text is available yet for this article.
October 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27478148/cpr-induced-consciousness-a-cross-sectional-study-of-healthcare-practitioners-experience
#3
Alexander Olaussen, Matthew Shepherd, Ziad Nehme, Karen Smith, Paul A Jennings, Stephen Bernard, Biswadev Mitra
INTRODUCTION: Consciousness may occur during effective management of cardiac arrest and ranges from eye opening to interfering with rescuers' resuscitation attempts. Reported cases in the medical literature appear scant compared to anecdotal reports. The aim of this study was to evaluate health care providers' experience with consciousness during cardio-pulmonary resuscitation (CPR). METHODS: A cross-sectional survey of 100 experienced health care professionals, including doctors, nurses and paramedics...
July 28, 2016: Australasian Emergency Nursing Journal: AENJ
https://www.readbyqxmd.com/read/27411984/a-population-based-study-of-drowning-in-canada
#4
Tessa Clemens, Hala Tamim, Michael Rotondi, Alison K Macpherson
BACKGROUND: Although water-related fatality rates have changed over time, the epidemiology of drowning in Canada has not recently been examined. In spite of the evidence supporting varying drowning death rates by age, information on how characteristics of drowning incidents differ by age group remains limited. The primary objective of this study was to examine the epidemiology of drowning in Canada. A secondary objective was to describe the characteristics of these drowning incidents as they vary by age group...
July 13, 2016: BMC Public Health
https://www.readbyqxmd.com/read/26680137/prehospital-interventions-in-severely-injured-pediatric-patients-rethinking-the-abcs
#5
Kyle K Sokol, George E Black, Kenneth S Azarow, William Long, Matthew J Martin, Matthew J Eckert
BACKGROUND: The current conflict in Afghanistan has resulted in a high volume of significantly injured pediatric patients. The austere environment has demanded emphasis on prehospital interventions (PHIs) to sustain casualties during transport. METHODS: The Department of Defense Trauma Registry was queried for all pediatric patients (≤18 years) treated at Camp Bastion from 2004 to 2012. PHIs were grouped by Advanced Trauma Life Support categories into (1) airway (A)--intubation or surgical airway; 2) breathing (B)--chest tube or needle thoracostomy; and 3) circulation (C)--tourniquet or hemostatic dressing...
December 2015: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27342573/mechanical-circulatory-assist-devices-a-primer-for-critical-care-and-emergency-physicians
#6
REVIEW
Ayan Sen, Joel S Larson, Kianoush B Kashani, Stacy L Libricz, Bhavesh M Patel, Pramod K Guru, Cory M Alwardt, Octavio Pajaro, J Christopher Farmer
Mechanical circulatory assist devices are now commonly used in the treatment of severe heart failure as bridges to cardiac transplant, as destination therapy for patients who are not transplant candidates, and as bridges to recovery and "decision-making". These devices, which can be used to support the left or right ventricles or both, restore circulation to the tissues, thereby improving organ function. Left ventricular assist devices (LVADs) are the most common support devices. To care for patients with these devices, health care providers in emergency departments (EDs) and intensive care units (ICUs) need to understand the physiology of the devices, the vocabulary of mechanical support, the types of complications patients may have, diagnostic techniques, and decision-making regarding treatment...
June 25, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/26496112/redefining-dead-on-arrival-identifying-the-unsalvageable-patient-for-the-purpose-of-performance-improvement
#7
James P Byrne, Wei Xiong, David Gomez, Stephanie Mason, Paul Karanicolas, Sandro Rizoli, Homer Tien, Avery B Nathens
BACKGROUND: Significant variation exists across registries in the criteria used to identify patients with no chance of survival, with potential for profound impact on trauma center mortality. The purpose of this study was to identify the optimal case definition for the unsalvageable patient, for the purpose of exclusion from performance improvement (PI) endeavors. METHODS: Data were derived from the American College of Surgeons' Trauma Quality Improvement Program for 2012 to 2013...
November 2015: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27352210/prehospital-factors-associated-with-an-acute-life-threatening-condition-in-non-traumatic-chest-pain-patients-a-systematic-review
#8
REVIEW
Kristoffer Wibring, Johan Herlitz, Lennart Christensson, Markus Lingman, Angela Bång
BACKGROUND: Chest pain is a common symptom among patients contacting the emergency medical services (EMS). Risk stratification of these patients is warranted before arrival in hospital, regarding likelihood of an acute life-threatening condition (LTC). AIM: To identify factors associated with an increased risk of acute LTC among patients who call the EMS due to non-traumatic chest pain. METHODS: Several databases were searched for relevant articles...
September 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27344928/dual-defibrillation-in-out-of-hospital-cardiac-arrest-a-retrospective-cohort-analysis
#9
Elliot M Ross, Theodore T Redman, Stephen A Harper, Julian G Mapp, David A Wampler, David A Miramontes
STUDY OBJECTIVES: The goal of our study is to determine if prehospital dual defibrillation (DD) is associated with better neurologically intact survival in out-of-hospital cardiac arrest. METHODS: This study is a retrospective cohort analysis of prospectively collected Quality Assurance/Quality Improvement data from a large urban fire based EMS system out-of-hospital cardiac arrest (OHCA) database between Jan 2013 and Dec 2015. Our inclusion criteria were administration of DD or at least four conventional 200J defibrillations for cases of recurrent and refractory ventricular fibrillation (VF)...
September 2016: Resuscitation
https://www.readbyqxmd.com/read/27225648/reactions-and-coping-strategies-in-lay-rescuers-who-have-provided-cpr-to-out-of-hospital-cardiac-arrest-victims-a-qualitative-study
#10
Wenche Torunn Mathiesen, Conrad Arnfinn Bjørshol, Geir Sverre Braut, Eldar Søreide
OBJECTIVE: Cardiopulmonary resuscitation (CPR) provided by community citizens is of paramount importance for out-of-hospital cardiac arrest (OHCA) victims' survival. Fortunately, CPR rates by community citizens seem to be rising. However, the experience of providing CPR is rarely investigated. The aim of this study was to explore reactions and coping strategies in lay rescuers who have provided CPR to OHCA victims. METHODS, PARTICIPANTS: This is a qualitative study of 20 lay rescuers who have provided CPR to 18 OHCA victims...
2016: BMJ Open
https://www.readbyqxmd.com/read/27211834/impact-brain-apnoea-a-forgotten-cause-of-cardiovascular-collapse-in-trauma
#11
REVIEW
Mark H Wilson, John Hinds, Gareth Grier, Brian Burns, Simon Carley, Gareth Davies
OBJECTIVE: Early death following cranial trauma is often considered unsurvivable traumatic brain injury (TBI). However, Impact Brain Apnoea (IBA), the phenomenon of apnoea following TBI, may be a significant and preventable contributor to death attributed to primary injury. This paper reviews the history of IBA, cites case examples and reports a survey of emergency responder experience. METHODS: Literature and narrative review and focused survey of pre-hospital physicians...
August 2016: Resuscitation
https://www.readbyqxmd.com/read/27043165/amiodarone-lidocaine-or-placebo-in-out-of-hospital-cardiac-arrest
#12
RANDOMIZED CONTROLLED TRIAL
Peter J Kudenchuk, Siobhan P Brown, Mohamud Daya, Thomas Rea, Graham Nichol, Laurie J Morrison, Brian Leroux, Christian Vaillancourt, Lynn Wittwer, Clifton W Callaway, James Christenson, Debra Egan, Joseph P Ornato, Myron L Weisfeldt, Ian G Stiell, Ahamed H Idris, Tom P Aufderheide, James V Dunford, M Riccardo Colella, Gary M Vilke, Ashley M Brienza, Patrice Desvigne-Nickens, Pamela C Gray, Randal Gray, Norman Seals, Ron Straight, Paul Dorian
BACKGROUND: Antiarrhythmic drugs are used commonly in out-of-hospital cardiac arrest for shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, but without proven survival benefit. METHODS: In this randomized, double-blind trial, we compared parenteral amiodarone, lidocaine, and saline placebo, along with standard care, in adults who had nontraumatic out-of-hospital cardiac arrest, shock-refractory ventricular fibrillation or pulseless ventricular tachycardia after at least one shock, and vascular access...
May 5, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/26897074/could-ten-questions-asked-by-the-dispatch-center-predict-the-outcome-for-patients-with-chest-discomfort
#13
Nina Rawshani, Araz Rawshani, Carita Gelang, Johan Herlitz, Angela Bång, Jan-Otto Andersson, Martin Gellerstedt
BACKGROUND AND AIMS: From 2009 to 2010, approximately 14,000 consecutive persons who called for the EMS due to chest discomfort were registered. From the seventh month, dispatchers ask 2285 patient ten pre-specified questions. We evaluate which of these questions was independently able to predict an acute coronary syndrome (ACS), life-threatening condition (LTC) and death. METHODS: The questions asked mainly dealt with previous history and type of symptoms, each with yes/no answers...
April 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/26951821/sudden-cardiac-death-in-the-young
#14
REVIEW
Michael Ackerman, Dianne L Atkins, John K Triedman
Although the occurrence of sudden cardiac death (SCD) in a young person is a rare event, it is traumatic and often widely publicized. In recent years, SCD in this population has been increasingly seen as a public health and safety issue. This review presents current knowledge relevant to the epidemiology of SCD and to strategies for prevention, resuscitation, and identification of those at greatest risk. Areas of active research and controversy include the development of best practices in screening, risk stratification approaches and postmortem evaluation, and identification of modifiable barriers to providing better outcomes after resuscitation of young SCD patients...
March 8, 2016: Circulation
https://www.readbyqxmd.com/read/16032622/electrocardiographic-st-segment-elevation-in-the-trauma-patient-acute-myocardial-infarction-vs-myocardial-contusion
#15
Claire U Plautz, Andrew D Perron, William J Brady
The diagnosis of myocardial contusion in the setting of blunt trauma engenders much discussion and controversy-partly because of the lack of a gold standard for its identification other than histologic findings at autopsy. Furthermore, blunt cardiac trauma represents a spectrum of disorders ranging from transient electrocardiographic change to sudden death from myocardial rupture; hence, no single terminology exists to define such a wide range of scenarios. Here, we present 2 cases of electrocardiographic ST-segment elevation after high-speed motor vehicle crashes resulting in numerous injuries, including blunt chest trauma...
July 2005: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/26948870/paramedics-involvement-in-planned-home-birth-a-one-year-case-study
#16
Gayle McLelland, Lisa McKenna, Amee Morgans, Karen Smith
OBJECTIVE: to report findings from a study performed prior to the introduction of publicly funded home birth programmes in Victoria, Australia, that investigated the incidence of planned home births attended by paramedics and explored the clinical support they provided as well as the implications for education and practice. METHODS: retrospective data previously collected via an in-field electronic patient care record (VACIS(®)) was provided by a state-wide ambulance service...
July 2016: Midwifery
https://www.readbyqxmd.com/read/26886000/not-all-prehospital-time-is-equal-influence-of-scene-time-on-mortality
#17
Joshua B Brown, Matthew R Rosengart, Raquel M Forsythe, Benjamin R Reynolds, Mark L Gestring, William M Hallinan, Andrew B Peitzman, Timothy R Billiar, Jason L Sperry
BACKGROUND: Trauma is time sensitive, and minimizing prehospital (PH) time is appealing. However, most studies have not linked increasing PH time with worse outcomes because raw PH times are highly variable. It is unclear whether specific PH time patterns affect outcomes. Our objective was to evaluate the association of PH time interval distribution with mortality. METHODS: Patients transported by emergency medical services in the Pennsylvania trauma registry from 2000 to 2013 with a total PH time (TPT) of 20 minutes or longer were included...
July 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/26836060/is-it-appropriate-for-patients-to-be-discharged-at-the-scene-by-paramedics
#18
Hideo Tohira, Daniel Fatovich, Teresa A Williams, Alexandra P Bremner, Glenn Arendts, Ian R Rogers, Antonio Celenza, David Mountain, Peter Cameron, Peter Sprivulis, Tony Ahern, Judith Finn
BACKGROUND: Outcomes of patients who are discharged at the scene by paramedics are not fully understood. OBJECTIVE: We aimed to describe the risk of re-presentation and/or death in prehospital patients discharged at the scene. METHODS: We conducted a retrospective cohort study using linked ambulance, emergency department (ED), and death data. We compared outcomes in patients who were discharged at the scene by paramedics with those who were transported to ED by paramedics and then discharged from ED between January 1 and December 31, 2013 in metropolitan Perth, Western Australia...
July 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/25593060/remote-ischemic-conditioning
#19
REVIEW
Gerd Heusch, Hans Erik Bøtker, Karin Przyklenk, Andrew Redington, Derek Yellon
In remote ischemic conditioning (RIC), brief, reversible episodes of ischemia with reperfusion in one vascular bed, tissue, or organ confer a global protective phenotype and render remote tissues and organs resistant to ischemia/reperfusion injury. The peripheral stimulus can be chemical, mechanical, or electrical and involves activation of peripheral sensory nerves. The signal transfer to the heart or other organs is through neuronal and humoral communications. Protection can be transferred, even across species, with plasma-derived dialysate and involves nitric oxide, stromal derived factor-1α, microribonucleic acid-144, but also other, not yet identified factors...
January 20, 2015: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/26427535/a-16-year-old-with-st-elevation-myocardial-infarction-case-report-and-review-of-the-literature
#20
REVIEW
Dustin Hill, Adam Waldman, Deepak Vivek
Chest pain in young adults presents a unique diagnostic challenge, placing young patients at an increased risk to be misdiagnosed, as this patient population typically does not demonstrate the traditional risk factors associated with cardiovascular disease. This study details the case of a 16-year-old male who presented with new-onset chest pain and ST elevation on electrocardiogram. His history was unremarkable for known cardiac risk factors, but laboratory evaluation demonstrated markedly elevated troponins and electrocardiographic findings confirmed ST-segment elevation myocardial infarction...
February 2016: Cardiology in the Young
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